ACL surgery for dog

[Tiggeroo]

I have a one year old corgi. Since august he has had an on and off injury. If he plays too much he doesn't put much weight on his one leg. Lately it's been worst where he has a very difficult time getting up if he's been sitting long. He's been to the vets several times had the leg x-rayed and taken anti inflammatories and a course of steroids. With this and a good deal of rest it will get much better and then he runs a bit and it's back.
The dr now feels like its his knee/acl and the solution is surgery. He is scheduled for surgery when the dr will sedate him and manipulate the knee to see if it is the problem and x-ray the hips and spine. If its the knee hell do the surgery right then.
Any advise? I'm concerned about the cost. 1700. Which half insurance should reimburse. Recovery which means no exercise or play at all for two months. This means we have to carry him up and down the stairs for walks. Also his lack of exercise has caused him to put on some weight. These two months would mean even less exercise. The risk of complications. The fact that they can give me no proof it is this. I hear that once you do one leg they often need the other one. I want to do what is right for him. .

 

[roxysmum123]

Personally, on a one year old dog, if it IS an ACL thing and they do find they need to go ahead and do the corrective surgery, you'll get your return on investment. For me, I'd do it. The "no exercise/no play for 2 months" goes VERY fast, and it beats having to tote the little guy around for years if it's a major injury that doesn't get addressed soon enough.

Get a second opinion, preferably from a veterinary ortho, but if it's the same as your docs I'd be doing the surgery.

 

[Tiggeroo]

Will another vet be able to see the problem without anesthesia and x-rays? The vet is minimizing his exposure and keeping costs lower by doing the X-rays the same day he is getting anesthesia for surgery. He says a dog won't relax the leg enough without sedation to manipulate the knee.

 

[roxysmum123]

Not necessarily but another vet may have a different course of treatment to recommend. Also, if you see a specialist they're more experienced with these kinds of injuries so may be better able to know what's going on.

Anytime the course of treatment is over $1000 on my animals, I get a second opinion. Because if the surgery is that expensive to begin with, if it's wrong or get screwed up it'll be equally expensive to correct if it wasn't the appropriate course of treatment.

 

[WDWBarb]

My GSD had a torn ACL when she was 4 and the only options we considered were which type of surgery (the traditional or the newer TPLO) - we never considered not performing it. It is expensive but very much worth it. Recovery IS difficult (and it didn't go quickly for me - my GSD was hyper and very active and keeping her calm wasn't easy).

But it's been 5 years since her surgery and we have, of course, never regretted it. She's never had a problem with that knee since (and we did choose to do the TPLO).

 

[crjack]

We did the TPLO surgery for our lab mix about two years ago....it was expensive (wish it was $1700) and the first week to ten days of the recovery was tough but overall it was very successful and we have not had any other injuries or issues since the surgery. (Our dog is lab/border collie so you can imagine how active he is)

I know it can be a little different with smaller dogs. Not sure how big your corgi is but since our dog is over 50 lbs we went with the TPLO. It seems to be recommended for larger dogs and helps to reduce the chance of injuring the other leg because they dont have to over compensate since they regain so much strength and mobility. With smaller dogs the more traditional method seems to be used sucessfully.

Without x-rays I honestly dont know how you will get another opinion but I would want to be comfortable with how familiar your vet or surgeon is with performing the surgery.

The pricing seems very much in line from my experience and I did research it quite a bit as well for our dog.

I think you may find your dog is doing much better long before two months. You will have to watch the activity level but our dog was given permission for walks after a few weeks and we gradually made them longer. It helped to calm him and also maintain his weight.

Best of luck.

 

[Pea-n-Me]

This is not something I'd rush into.

This is definitely not something I'd rush into with a Corgi who's 17lbs overweight. He'll be a higher surgical risk and his recovery will be hampered by the extra weight.

We still don't even know if the weight is the biggest part of the problem (which it in fact may be).

I'll stick to my original thought on your first thread that I'd get the weight off first and reassess what needs to be done then.

I do realize you're trying to save money by doing the XRays and the surgery (if needed) on one shot. But there's no way I'd do a surgery like this unless it was absolutely, unequivocally necessary. That scalpel wouldn't be anywhere near the knee during the XRays.

 

[Tiggeroo]

The surgery is tentatively scheduled for thirty days out. The vet does not seem concerned about waiting a bit as long as he takes it easy. His concern is surgery before he gets arthritis or that compensating could hurt something else. He's on wellness diet now and can do several short walks a day to get the weight off. I do want to get a second opinion. The vet didn't say the type of surgery but I'll look at the paperwork to see.
The weight didn't cause the injury. He was a normal weight and very active when he hurt it in August. He went to dog beach or dog park at least four times a week and long walks. All the weight has been gained since. He's now down 9 pounds and needs to lose another 8-10. I am hoping that if surgery is necessary we can get another five off by then.
Btw. Whoever recommended wellness he loves it and is much less hungry.

 

[marie1203]

It really depends how much you trust your vet. I am very picky when it comes to our vet and now we have one that is great. I know that if he suggest it is because it is needed. I would asked how much experience your vet has with this particular problem. I would not go with what is cheaper it could end up costing you more. If my dogs was having problems there is no doubt I would do what he vet recommended. Very close friend had a similar situation she decided to go to a specialist and her dog is doing great . She did take her dog to therapy after the surgery once a week.

 

[Tiggeroo]

We are pretty new to the vet. Around seven months. But he came highly recommended. He says he does this procedure often.

 

[LadyZolt]

If you research this, you will find out that a dog weighing about 30 pounds or less generally does as well without the surgery as with, provided you restrain him (as you must if you have the surgery anyway) for at least 8 weeks, and preferably 12 weeks, where he cannot jump up and down off things, or go up and down stairs, etc. We have a small dog (12 pound terrier mix) who had the same kind of ACL problem you mention. We confined her to an area where she can't go up or down stairs and couldn't jump on furniture, etc., for 12 weeks, and she was then much better and was walking like normal again. She was at the time around 8 years old, and now she's 11. We still do not let her go up any stairs because she will re-injure it if she goes down stairs regularly.

As you said, many times they will injure the other knee, too, after surgery (possibly because the operated on leg hurts, so they use the other one more, causing it to become injured as well.) Also, many times, a dog will re-injure the ACL right after surgery, by biting or licking, etc., which defeats the whole purpose of the surgery. And, if you do have the surgery, you still absolutely must confine him for at least 8 weeks. So, with a small dog like a corgi, I would confine him first for 8 to 12 weeks because he will probably be much improved (and as improved as he'd be with the surgery, too). Because he's so young, I think once he's better, if you train him to not jump up and down off of furniture or other stuff, and don't have him climbing flights of stairs, you could avoid him re-injuring it. I wish you the best!

-Dorothy (LadyZolt)

 

[Jey12]

I have assisted with ACL injuries, the diagnosis, the actual surgery as well as client education on aftercare on too many cases to count. A corgi is not a small dog and due to their body structure, short stubby legs, rest probably is not going to work long term. Not to mention they are a high energy dog and if you try to restrain or limit exercise long term they are going to destroy your house. Honestly I'm not really sure why a sedative wasn't used for the first set of xrays? It's next to impossible to ask a dog to relax enough to get a good view of legs, hips or shoulders. I would at least let the Dr. do the sedative and xrays. You really aren't going to get a solid answer until the dog is examined under sedation. While under sedation the leg will relax and the Dr. can manipulate the knee well enough to know if it's an ACL tear or something else. The xrays will help to confirm or deny what they are feeling. I worked with an excellent ortho vet for years and I'd trust his hands over what the xray was saying anyday, but he never did one without the other. It's just good practice to do both. I wouldn't fully trust someone who could say 100% it was an ACL tear without sedating the dog. The hips will be xrayed to make sure the problem isn't there and that they are also sound enough to handle the added stress after surgery.

Last year, lucky me, both of my dogs blew their knees a month apart from one another. One was an ACL while the other was a MPL. Both dogs are large breed dogs and over the age of 10. I elected, and confirmed with my vet that the side effects and post surgical complications in dogs of their age far outweighed the benefit of surgery. We did comfort care and both dogs were able to heal somewhat with rest, and pain meds. If they had been under the age of 8 years I would have not hesitated to do the surgery. Because your dog is so young I honestly would, if you can, find a Dr. that can do the TPLO on the knee. This technique not only stabilizes the knee joint better than the old way of doing things, but the recovery is so much easier on most pets. Licking and chewing the wound shouldn't be of any concern because your dog should be sent home with an e-collar and that should be on your dog 24/7 following surgery for at least 2 weeks. I know it sucks for you and the dog but it's much better than fighting an infected wound or having to resedate and resuture.

It's somewhat common for the other knee to go after surgery in around 1/3 of cases. This is due to the stress put on the other leg, but that's already happening anyway. If you don't fix at least one leg you'll have a dog with two injured back legs, possibly. Also sometimes it's a genetic issue and what's caused the problem in one leg is also present in the other.

I would ask your vet about their experience with doing an ACL surgery. The basic kind of repair is fairly common and most vets do know how to correctly do it. I would also seek a second opinion with a vet that is skilled with doing both the regular repair and an TPLO. I would let your vet do the xrays and then you can take them with you to a specialist. Most specialist won't even discuss surgery with you until they see an xray and feel the knee themselves. They can possibly do a good exam without sedation because they will have the notes from your Dr. and the xray of the sedated dog in front of them. Make sure your vet also xrays the other knee at the same time so there's a comparison. There's nothing wrong with getting a 2nd opinion and I would recommend it in this instance. The cost you were quoted is about right. Double check with your dog's insurance company to make sure they wlll cover this. Sometimes they will say it's a breed issue and it's not covered. You don't want to be surprised if you are denied. I've had this happen and I wasn't a happy camper.

Best of luck. The recovery post surgical won't be easy, there's no getting around that. If it is an ACL in such a young dog you will be happy you did the surgery years from now.

 

[Jabali]

My Australian Shepherd had ACL surgery done when he was 1 or just before it.....the recovery was a little hard for him, especially since they're such an active breed. But he fared well, and didn't take him long before he was as good as ever.

 

[Pea-n-Me]

It really depends how much you trust your vet. I am very picky when it comes to our vet and now we have one that is great. I know that if he suggest it is because it is needed. I would asked how much experience your vet has with this particular problem. I would not go with what is cheaper it could end up costing you more. If my dogs was having problems there is no doubt I would do what he vet recommended.

With all due respect, I'll have to take exception to this advice.

I trust my vets, but there have been times they haven't been right.

OTOH, there are vets I don't know or yet trust, who have been.

Like with human doctors and medicine, you go to a doctor for advice, then you analyze that advice, do your own research, search your own heart, and decide if you want to take it. Sometimes you do, sometimes you don't. Oftentimes you are given choices, and you decide which choice is right for you. Different doctors can have different opinions.

This is a major surgery and major expense with long lasting implications for everyone.

We don't even have XRays yet and we're planning for major surgery.

He says he does this procedure often.

(This is a red flag as well, IMO.)

The dog also has body habitus issues that are concerning for health and surgery/recovery which could very well be a big part of the problem.

In fairness to the vet, I do think the vet was trying to offer the OP a solution of "saving money" in a roundabout way by doing the XRays and the surgery on the same day. (Who wouldn't have concerns about a $1700 surgery? )

I've had 6 very active German Shepherd Dogs who've had their (abundant) share of limping/soreness issues over the years. (One was a frisbee/agility dog.) Not once has this type of surgery ever been suggested or needed. (One of the reasons I like my vets - they generally take a conservative approach first.) One of my dogs died during unnecessary surgery and there is NO WAY in double hockeysticks I'll ever make that mistake again. (I have had dogs have surgeries since then but they were surgeries that were absolutely necessary.) In every one of my dogs, acute limping/soreness issues always resolved with a few days of rest and TLC.

I do have a friend who had a 1yr old GSD whom another vet recommended the ACL surgery for. My friend had elected to do the surgery but had a family emergency and it was postponed. In the interim, with rest, the problem resolved; even the vet agreed surgery was not needed at that point and he was fine after that. Had they not had an emergency, the sugery would have been done.

It almost seems to me like ACL surgery is the "C. Section" of the dog world these days.

What happens to dogs with ACL injuries who can't afford the surgery? What happened in the past to dogs with these "injuries" before these surgeries became "popular"? Did they all become crippled? Food for thought...

(Not trying to offend anyone who's elected to have the surgery, either. I'm sure you had your reasons.

Besides, I probably just jinxed myself if it's any consolation. )

 

[TexasErin]

My Great Pyrenees had the TPLO surgery in July after us having tried to take a wait and see approach first- hoping with Previcox and rest that she would get better......no such luck.....so we were told that although we could wait a couple of weeks (which seemed like that was mainly because the specialist was on vacation), but if she didn't have the other surgery that her other leg would blow so she'd have to be put to sleep. So she had the first TPLO. Recovery was okay, but you could tell she still struggled to lift her butt off the ground. I was told she's no spring chicken (she is 7), so that should be expected.

So three months later the other knee blew. Another $2300 later and healing has not been as good on this leg. She just went in for her eight-week follow-up. They sedated her again to x-ray her to see why she's still walking with a hitch in her step. Turns out she now has a broken fibula, which can sometimes happen. More confinement- she's had a horrible six months and this is putting us so FAR in debt. I'm thinking this is never gonna end!

However I guess she'd have had to be put to sleep when the other knee blew if we hadn't done the surgery......so what do you do?????

I hope you have way better luck than we have- and I pray life is good again for Molly one day....

 

[Pea-n-Me]

I don't know if it's being done, but if these were people it would be.

Someone should be analyzing the data on everything related to a) doing the surgery, b) not doing the surgery, c) how often the other knee blows with the surgery, d) how often the other knee blows without the surgery, etc.

I imagine in the dog population it would be difficult since they may not see dogs with these types of injuries to begin with and/or they may be lost to follow up.

If it could be studied correctly, I'd be very interested in seeing the data.

Erin, hugs to you and Molly.

 

[Pea-n-Me]

After my last post I decided to look around and see if there were any such studies.

I found an interesting website (for the first time) that I think would be worthwhile reading for anyone dealing with this type of problem (in addition to reading other types of research, in order to help make an informed decision).

"...There are no studies that I know of that compare [ligament injury] surgery success to doing nothing over the lifetime of dogs who have one or the other experience. I think that these studies don't exist because they never looked very good for the surgery and so surgeons weren't too interested in doing them..." -
--- Author & vet Mike Richards DVM

Is Surgery Really Necessary For Your Dog's Ligament Injury?

http://www.tiggerpoz.com/

 

[LadyZolt]

A corgi is not a small dog and due to their body structure, short stubby legs, rest probably is not going to work long term. Not to mention they are a high energy dog and if you try to restrain or limit exercise long term they are going to destroy your house. .... The recovery post surgical won't be easy, there's no getting around that. If it is an ACL in such a young dog you will be happy you did the surgery years from now.

I agree with you on the sedative use, to make sure the dog is really sedated in order to check the knee properly. However, if the dog cannot be restrained and limited, then he will re-injure the leg post-surgery anyway. The dog can certainly exercise and play. He simply cannot do stuff that will injure the knee, such as jump up on furniture and climb stairs. The dog can certainly walk on a level area, play in the grass, do his business, etc. I am not suggesting putting him in a crate for 12 weeks. I am recommending limiting his knee use for 12 weeks, which, as I said (and any vet will tell you, and any web site talking about the surgery will tell you) is going to be required if the surgery is done anyway. I am suggesting trying to limit the dog (as if the surgery has already been done) for 8 to 12 weeks (preferably 12) and seeing how he is. If you cannot do this, then you cannot have the surgery, either, because the dog is at much higher risk of breaking open the surgical site and causing even greater damage.

I honestly see no reason not to try this method first. If it doesn't result in a better situation for the dog, then the surgery can always be performed later. This is a young dog who should be just as capable of having the surgery a year from now as now, and the owner has already said he is on a diet to lose weight. He really should be at close to his ideal weight before surgery anyway, so delaying the surgery is not risking his life or anything.

I read the site Pea-n-me posted before I opted to restrict my dog, and I am glad I did as her vet even said she is doing so well now, she (the vet) can not believe this dog ever had an ACL injury.

-Dorothy (ladyZolt)

 

[Jey12]

I agree with you on the sedative use, to make sure the dog is really sedated in order to check the knee properly. However, if the dog cannot be restrained and limited, then he will re-injure the leg post-surgery anyway. The dog can certainly exercise and play. He simply cannot do stuff that will injure the knee, such as jump up on furniture and climb stairs. The dog can certainly walk on a level area, play in the grass, do his business, etc. I am not suggesting putting him in a crate for 12 weeks. I am recommending limiting his knee use for 12 weeks, which, as I said (and any vet will tell you, and any web site talking about the surgery will tell you) is going to be required if the surgery is done anyway. I am suggesting trying to limit the dog (as if the surgery has already been done) for 8 to 12 weeks (preferably 12) and seeing how he is. If you cannot do this, then you cannot have the surgery, either, because the dog is at much higher risk of breaking open the surgical site and causing even greater damage.

I honestly see no reason not to try this method first. If it doesn't result in a better situation for the dog, then the surgery can always be performed later. This is a young dog who should be just as capable of having the surgery a year from now as now, and the owner has already said he is on a diet to lose weight. He really should be at close to his ideal weight before surgery anyway, so delaying the surgery is not risking his life or anything.

I read the site Pea-n-me posted before I opted to restrict my dog, and I am glad I did as her vet even said she is doing so well now, she (the vet) can not believe this dog ever had an ACL injury.

-Dorothy (ladyZolt)

I'm all for trying the easiest route possible first. In my first post you'd see I opted against surgery for both of my dogs, one having a torn ACL and one having a torn MPL. This was due to their age mainly. The OP stated this has been an ongoing problem since August, has had many trips to the vet, the dog has been on anti-inflammatory drugs, and has had x-rays (not under sedation), along with resting and restrictions. For me 6 months of doing this is probably long enough to know there's possibly a bigger problem going on, and the problem is not going to heal on its own. My dogs after a year with these issues still aren't back to 100%, they still require pain meds on and off and PT therapy I do at home. I don't ever expect them to be 100%, but it's better than the side effects of this surgery on what would now be a 13 year old GSD mix and a 11 year old Rottie mix.

The dog in question is a very young, active dog. If she hasn't healed in 6 months time IMO it's time to get a bit more aggressive with treatment. Since the injury seems to come and go I'd wonder if either the ACL hasn't torn all the way yet, or possibly the issue is in the hip? Of course no one can tell until the dog is sedated and xrays and an exam under the sedation is done.

Our post ACL protocol does not allow for free play outside. The dog is to be leashed at all times when out of the house, even in a fenced in backyard. Larger dogs are to be towel walked for the first several days after surgery. We recommend using a crate in the house when you cannot directly observe the dog for the first 30 days of the recovery time or until the vet clears the dog. This is in addition to no stairs, no jumping, no running, wearing an e-collar for a full 2 weeks, and no spinning in circles. The owners that actually followed these instructions rarely had post surgical complications. Running and playing most certainly can reinjure or cause a knee injury, not just jumping and stairs. My own dog tore her ACL running and playing at the dog park. If you as an owner are unable to follow the directions we do offer a reduced boarding rate for the 2 weeks post surgical.

I totally agree that restricting the dog for a period of time is what should be done first. It's already been done for 6 months per the OP. Now it's time to see what's really going on and what can be done about it since option A (R&R) hasn't produced desired results.

 

[Tiggeroo]

I'm all for trying the easiest route possible first. In my first post you'd see I opted against surgery for both of my dogs, one having a torn ACL and one having a torn MPL. This was due to their age mainly. The OP stated this has been an ongoing problem since August, has had many trips to the vet, the dog has been on anti-inflammatory drugs, and has had x-rays (not under sedation), along with resting and restrictions. For me 6 months of doing this is probably long enough to know there's possibly a bigger problem going on, and the problem is not going to heal on its own. My dogs after a year with these issues still aren't back to 100%, they still require pain meds on and off and PT therapy I do at home. I don't ever expect them to be 100%, but it's better than the side effects of this surgery on what would now be a 13 year old GSD mix and a 11 year old Rottie mix.

The dog in question is a very young, active dog. If she hasn't healed in 6 months time IMO it's time to get a bit more aggressive with treatment. Since the injury seems to come and go I'd wonder if either the ACL hasn't torn all the way yet, or possibly the issue is in the hip? Of course no one can tell until the dog is sedated and xrays and an exam under the sedation is done.

Our post ACL protocol does not allow for free play outside. The dog is to be leashed at all times when out of the house, even in a fenced in backyard. Larger dogs are to be towel walked for the first several days after surgery. We recommend using a crate in the house when you cannot directly observe the dog for the first 30 days of the recovery time or until the vet clears the dog. This is in addition to no stairs, no jumping, no running, wearing an e-collar for a full 2 weeks, and no spinning in circles. The owners that actually followed these instructions rarely had post surgical complications. Running and playing most certainly can reinjure or cause a knee injury, not just jumping and stairs. My own dog tore her ACL running and playing at the dog park. If you as an owner are unable to follow the directions we do offer a reduced boarding rate for the 2 weeks post surgical.

I totally agree that restricting the dog for a period of time is what should be done first. It's already been done for 6 months per the OP. Now it's time to see what's really going on and what can be done about it since option A (R&R) hasn't produced desired results.

Yes, this is it exactly. He was on very restricted activity, only short walks for bathroom on leash for 5 weeks. During this time he was on anti-inflammatory and steroids for a shorter period. He is also on a glucosamine supplement. then we began a period of gradually increasing his exercise. He appeared to be completely better. Once he resumed play he began having periods of limping for a day or two after wards. Our vet is being very conservative. He felt if it was acl it was only pulled and not torn. But recently it has gotten worst and he is still on fairly limited activity. He can often not get up from a sitting or lying position and sometimes he seems cranky. When he is asleep he cries.
The vet is not certain it is his knee. He can't be until the anesthesia. He is preparing us for surgery but telling us it won't be done if it's the hip or he does not discover the play in the knee. Because he was so young they were willing to give it more time. But he said that the longer we allow him to walk like this the more likely he will end up with arthritis at a young age.
However, he has said it is not urgent. We can spend some time getting some weight off and if we wish to try a longer rest period that is ok. For us, however recovery will definitely be easier in the winter. My son works three jobs in the summer and I will need his help getting the dog up and down the stairs during recovery. We live on a second floor condo.
We have thirty days at least. If we see a marked improvement over that time we will re-evaluate.
I am so glad there are many who have had this done successfully and others who have felt ok about not doing it. I will feel better with whatever decision I make. I would also like to get a second opinion.